Medications That Affect The Endocrine System

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Medications that Medications that Affect the Affect the

Endocrine SystemEndocrine System

Thyroid and Thyroid and Adrenocortical drugsAdrenocortical drugs

Anti-diabetic drugsAnti-diabetic drugs

11Created by Amanda McBrideCreated by Amanda McBride

DiabetesDiabetes

CONFIDENTIALCONFIDENTIAL33

2 Types of Diabetes2 Types of Diabetes

CONFIDENTIALCONFIDENTIAL 55

Anti-diabeticAnti-diabetic•InsulinInsulin•Oral Anti-Oral Anti-diabetic drugsdiabetic drugs

InsulinInsulin• Hormone manufactured by the beta cells of the Hormone manufactured by the beta cells of the

pancreaspancreas• Beta cells are located in the pancreas in Beta cells are located in the pancreas in

clusters known as the islets of Langerhans. clusters known as the islets of Langerhans. • Insulin is a small protein Insulin is a small protein • Required for the proper use of carbohydratesRequired for the proper use of carbohydrates• Controls the storage and utilization of amino Controls the storage and utilization of amino

acids and fatty acids.acids and fatty acids.• Lowers blood glucose levels by inhibiting Lowers blood glucose levels by inhibiting

glucose production by the liverglucose production by the liver

Action of InsulinAction of Insulin• Insulin molecules circulate throughout the blood stream until Insulin molecules circulate throughout the blood stream until

they bind to their associated (insulin) receptors. they bind to their associated (insulin) receptors. • Insulin receptors promote the uptake of glucose into various Insulin receptors promote the uptake of glucose into various

tissues that contain type 4 glucose transporters (GLUT4). tissues that contain type 4 glucose transporters (GLUT4). Such tissues include skeletal muscles (which burn glucose for Such tissues include skeletal muscles (which burn glucose for energy) and fat tissues (which convert glucose to triglycerides energy) and fat tissues (which convert glucose to triglycerides for storage). for storage).

• The initial binding of insulin to its receptor initiates a signal The initial binding of insulin to its receptor initiates a signal transduction cascade that communicates the message transduction cascade that communicates the message delivered by insulin: remove glucose from blood plasma .delivered by insulin: remove glucose from blood plasma .

• By the facilitative transport of glucose into the cells, the By the facilitative transport of glucose into the cells, the glucose transporters effectively remove glucose from the glucose transporters effectively remove glucose from the blood stream. blood stream.

• These changes can last from minutes to hours. These changes can last from minutes to hours.

Human InsulinHuman Insulin• Less allergic reactions than Less allergic reactions than

animal insulinanimal insulin• Structurally similar to human Structurally similar to human

insulininsulin

ActionAction• Activate a process that helps Activate a process that helps

glucose molecules enter the cells of glucose molecules enter the cells of striated muscle and adipose tissuestriated muscle and adipose tissue

• Stimulates the synthesis of Stimulates the synthesis of glycogen by the liver.glycogen by the liver.

• Promotes protein synthesis and Promotes protein synthesis and helps the body store fat by helps the body store fat by preventing its breakdown for preventing its breakdown for energy.energy.

Onset, Peak, Onset, Peak, DurationDuration• Onset Onset

• When insulin first begins to act in the When insulin first begins to act in the bodybody

• PeakPeak• When the insulin is exerting max actionWhen the insulin is exerting max action

• DurationDuration• The length of time the insulin remains The length of time the insulin remains

in effectin effect

UsesUses• Diabetes type 1Diabetes type 1• Diabetes type 2 when uncontrolled Diabetes type 2 when uncontrolled

by diet, exercise or weight by diet, exercise or weight reductionreduction

• Treat severe DKA or diabetic comaTreat severe DKA or diabetic coma• Treat hypokalemia in combination Treat hypokalemia in combination

with glucosewith glucose

Adverse Adverse ReactionsReactions• HypoglycemiaHypoglycemia

• Too little foodToo little food• Too much InsulinToo much Insulin• Increased demandIncreased demand

• HyperglycemiaHyperglycemia• Too much foodToo much food• Too little InsulinToo little Insulin• Emotional stress, infection, surgery, pregnancy or Emotional stress, infection, surgery, pregnancy or

acute illnessacute illness• Increased Insulin resistanceIncreased Insulin resistance

• Antibodies develop against InsulinAntibodies develop against Insulin

PrecautionsPrecautions•Hepatic impairmentHepatic impairment•Renal impairmentRenal impairment•Pregnancy Pregnancy •LactationLactation

InteractionsInteractions•Drug that affect Drug that affect

effectivenesseffectiveness

Nursing Nursing ProcessProcess• AssessmentAssessment

•SkinSkin•v/sv/s•DietDiet•Type and duration of symptomsType and duration of symptoms•Blood workBlood work•S&S hypo/hyper glycemiaS&S hypo/hyper glycemia

ImplementationImplementation• Doses highly individualizedDoses highly individualized• Daily doseDaily dose• Sliding scale based on glucometer readingSliding scale based on glucometer reading• Mixing InsulinsMixing Insulins

• Mix in the same syringeMix in the same syringe• Clear to cloudyClear to cloudy

• Insulin syringeInsulin syringe• Check date openedCheck date opened• Second checker/co-signerSecond checker/co-signer• Rotate suspension to mix insulinRotate suspension to mix insulin• Rotate sites to prevent lipodystrophyRotate sites to prevent lipodystrophy• Hypoglycemic reactionHypoglycemic reaction

• Orange juiceOrange juice• Honey hard candyHoney hard candy• Commercial gluoose productsCommercial gluoose products• GlucagonGlucagon• Glucose IVGlucose IV

EvalutionEvalution•CopingCoping•EducationEducation•EffectivenessEffectiveness

Diabetic KetoacidosisDiabetic Ketoacidosis

Oral Anti-diabetic Oral Anti-diabetic drugsdrugs

SulfonylureasSulfonylureas

BiguanidesBiguanides

Alpha inhibitorsAlpha inhibitors

MeglitinidesMeglitinides

ThiazolidinedionesThiazolidinediones2424Created by Amanda McBrideCreated by Amanda McBride

UseUse•Only in the treatment of type 2 Only in the treatment of type 2

diabetesdiabetes•May be used with InsulinMay be used with Insulin•Some can be used together Some can be used together

when one antidiabetic drug when one antidiabetic drug and diet do not control blood and diet do not control blood glucoseglucose

Actions, Actions, Adverse Adverse reaction, reaction,

ContraindicatiContraindications, ons,

Precautions Precautions and and

InteractionsInteractions 2727Created by Amanda McBrideCreated by Amanda McBride

SulfonylureasSulfonylureas• ActionAction

• Stimulate beta cellsStimulate beta cells• Not effective unless beta cells workNot effective unless beta cells work• DiaBeta/ glyburideDiaBeta/ glyburide

• Side effectsSide effects• Hypoglcemia, anorexia, nausea, vomiting, wt gain, Hypoglcemia, anorexia, nausea, vomiting, wt gain,

weakness numbnessweakness numbness• ContraindicatedContraindicated

• CAD, liver renal dysfunctionCAD, liver renal dysfunction• Sulpha drug allergySulpha drug allergy• Drug- drug interactionsDrug- drug interactions

BiguanidesBiguanides• ActionAction

• Decreasing hepatic glucose productionDecreasing hepatic glucose production• Increasing insulin sensitivity in muscle and fat cellsIncreasing insulin sensitivity in muscle and fat cells• Sensitizes the liver to circulating Insulin levelsSensitizes the liver to circulating Insulin levels• Glucophage / metforminGlucophage / metformin

• Side effectsSide effects• GI upset, lactic acidosisGI upset, lactic acidosis• weight lossweight loss

• ContraindicatedContraindicated• Heart failure, renal disease, metabolic acidosis, Heart failure, renal disease, metabolic acidosis,

pregnancypregnancy

a-Glucosidase a-Glucosidase InhibitorsInhibitors

• ActionAction• Delay the digestion and absorption of carbsDelay the digestion and absorption of carbs• PrandasePrandase

• Side effectsSide effects• GI disturbancesGI disturbances

• ContraindicationsContraindications• Type 1 diabetesType 1 diabetes• PregnancyPregnancy• Renal impairmentRenal impairment• Preexisting GI problemsPreexisting GI problems

MeglitinidesMeglitinides• ActionAction

• Stimulate the release of Insulin from pancreasStimulate the release of Insulin from pancreas• More rapid acting, shorter durationMore rapid acting, shorter duration• PrandinPrandin

• Side effectsSide effects• Hypoglycemia, URI, headache, bronchitis, back painHypoglycemia, URI, headache, bronchitis, back pain

• ContraindicationsContraindications• Type 1 diabetesType 1 diabetes• PregnancyPregnancy• Renal hepatic impairmentRenal hepatic impairment• Drug- drug interactionsDrug- drug interactions

ThiazolidinedionesThiazolidinediones• ActionAction

• Decrease Insulin resistanceDecrease Insulin resistance• Increase Insulin sensitivityIncrease Insulin sensitivity• AvandiaAvandia

• Side effectsSide effects• Aggravated diabetesAggravated diabetes• URIURI• SinusitisSinusitis• HeadacheHeadache• DiarrheaDiarrhea

• ContraindicationsContraindications• Severe heart failureSevere heart failure• EdemaEdema• CV diseaseCV disease• Liver kidney diseaseLiver kidney disease• Decrease the effect of oral contraceptivesDecrease the effect of oral contraceptives

• Use Avandia with caution if you have a problem with Use Avandia with caution if you have a problem with fluid retention or swelling. The drug has been known to fluid retention or swelling. The drug has been known to cause this problem ,which in turn can lead to heart cause this problem ,which in turn can lead to heart failure. Avandia should be avoided by anyone who has failure. Avandia should be avoided by anyone who has been diagnosed with heart failure, and it should be been diagnosed with heart failure, and it should be discontinued by anyone who develops it. Make sure discontinued by anyone who develops it. Make sure doctor is aware of any heart problems you may have. doctor is aware of any heart problems you may have. Alert him immediately if you develop symptoms of Alert him immediately if you develop symptoms of heart failure such as fatigue and shortness of breath. heart failure such as fatigue and shortness of breath. * You should be aware that people taking Avandia tend to gain a * You should be aware that people taking Avandia tend to gain a weight, typically around 5 to 10 pounds. The cause is thought to weight, typically around 5 to 10 pounds. The cause is thought to be a combination of fluid retention and fat accumulationbe a combination of fluid retention and fat accumulation

Nursing Nursing ProcessProcess•Baseline assessment including Baseline assessment including

wtwt• IntegumentaryIntegumentary•Blood workBlood work

•Glycosylated hemoglobinGlycosylated hemoglobin•Monitor initially for Monitor initially for

hypoglycemiahypoglycemia

EducationEducation•Take as prescribedTake as prescribed•Avoid alcoholAvoid alcohol•Avoid strenuous exerciseAvoid strenuous exercise•Maintain good foot careMaintain good foot care•Medic alertMedic alert•Know the symptoms of Know the symptoms of

hypo/hyperhypo/hyper

Posterior and Anterior Posterior and Anterior Pituitary HormonesPituitary Hormones

• Posterior HormonesPosterior Hormones• VasopressinVasopressin• OxytocinOxytocin

• Anterior HormonesAnterior Hormones• ProlactinProlactin• LHLH• FSHFSH• TSHTSH• ACTHACTH• GHGH

VasopressinVasopressin• Used in the treatment of diabetes Used in the treatment of diabetes

insipidusinsipidus• Diabetes Insipidus results from a Diabetes Insipidus results from a

decreased production of antidiuretic decreased production of antidiuretic hormone ( vasopressin) , the hormone hormone ( vasopressin) , the hormone that normally prevents the kidney that normally prevents the kidney from producing too much urine.from producing too much urine.

• Helps the body to conserve water when Helps the body to conserve water when dehydrated.dehydrated.

Adrenocorticol Adrenocorticol HormonesHormones

Effects of Glucocorticoids on Body SystemsEffects of Glucocorticoids on Body SystemsSystem Effect of Glucocorticoids, Cortisol

CNS Euphoria and behavioural changesLower Seizure Threshold

Resp Opens airways. Stabilize mast cells, to inhibit release of bronchoconstrictive and inflammatory substances, eg histamine

GI Facilitation of fat absorptionIncreased acid, pepsin, and trypsin

Skeletal Muscle Weakness (excess and deficiency)Muscle atrophy (chronic excess)

Skin Atrophy and thinning (chronic excess)

Hematopeoietic system

Decrease in peripheral lymphocytes, monocytes, eosinophils, clotting timeIncrease in peripheral neutrophils, platelets, RBCsDecreased phagocyte competence

CVS Increased blood pressure (increased blood volume)

Kidneys Increased reabsorption of water, sodium, chlorideIncreased excretion of potassium, calcium

Bone Inhibition of collagen synthesis by fibroblastsAntagonism of Vitamin D

Inflammatory and Immune response

Decrease inflammatory response, decrease capillary permeability, decrease immune response, decrease antibodies, anti-allergic actions

UsesUses• Adrenocortical insufficiencyAdrenocortical insufficiency• Allergic reactionsAllergic reactions• Cancer Cancer • LupusLupus• Ulcerative colitisUlcerative colitis• Dermatologic conditionsDermatologic conditions• Rheumatic disordersRheumatic disorders• ShockShock• AsthmaAsthma• COPDCOPD• Spinal cord injury Spinal cord injury • Organ transplantation Organ transplantation

Adverse Adverse ReactionsReactions

•S&S Cushings S&S Cushings syndromesyndrome

• immunosuppression immunosuppression • hyperglycemia due to increased due to increased gluconeogenesis, , insulin resistance and impaired and impaired

glucose tolerance ("glucose tolerance ("steroid diabetes"); caution in those with "); caution in those with diabetes mellitus • increased increased skin fragility, easy fragility, easy bruising • reduced reduced bone density (osteoporosis, higher fracture risk, slower fracture repair) density (osteoporosis, higher fracture risk, slower fracture repair) • weight gain due to increased visceral and truncal fat deposition (central obesity) weight gain due to increased visceral and truncal fat deposition (central obesity)

and appetite stimulation and appetite stimulation • adrenal insufficiency (if used for long time and stopped suddenly without a taper) adrenal insufficiency (if used for long time and stopped suddenly without a taper) • muscle breakdown (proteolysis), weakness; reduced muscle mass and repair muscle breakdown (proteolysis), weakness; reduced muscle mass and repair • expansion of malar fat pads and dilation of small blood vessels in skin expansion of malar fat pads and dilation of small blood vessels in skin • anovulation, irregularity of menstrual periods anovulation, irregularity of menstrual periods • growth failure, pubertal delay growth failure, pubertal delay • increased plasma amino acids, increased urea formation; negative nitrogen increased plasma amino acids, increased urea formation; negative nitrogen

balance balance • excitatory effect on central nervous system excitatory effect on central nervous system

CushingoidCushingoid

Contraindications, Contraindications, Precautions, Precautions, InteractionsInteractions• Containdicated with serious infectionsContaindicated with serious infections

• Renal hepatic impairmentRenal hepatic impairment• HypothyroidismHypothyroidism• Ulcerative colitisUlcerative colitis• Peptic ulcer diseasePeptic ulcer disease• HTNHTN• Convulsive disordersConvulsive disorders• DiabetesDiabetes• Multiple drug-drug interactionsMultiple drug-drug interactions

Mineralocorticoids-AldosteroneMineralocorticoids-Aldosterone

AldosteroneAldosterone

Action and Action and UseUse•Conserves salt Conserves salt

and waterand water•Replacement for Replacement for Addison’s diseaseAddison’s disease

Adverse Adverse ReactionsReactions• If dosage to high of withdrawal too If dosage to high of withdrawal too

rapidrapid• Edema, HTN, CHF, enlargement of Edema, HTN, CHF, enlargement of

the heartthe heart• Increased sweating, allergic skin Increased sweating, allergic skin

reactionreaction• Hypokalemia, muscle weakness, Hypokalemia, muscle weakness,

headacheheadache

Contraindications, Contraindications, Precautions, Precautions, InteractionsInteractions

•Fungal infectionFungal infection•Use cautiously with Addison’sUse cautiously with Addison’s• InfectionInfection•Decreased effects of Decreased effects of

hydantoins, rifampin, barbs, hydantoins, rifampin, barbs, salicylatessalicylates

Thyroid DrugsThyroid Drugs

System Effects of thyroid hormone

Metabolism

Lipid metabolism: Increased thyroid hormone levels stimulate fat mobilization, leading to increased concentrations of fatty acids in plasma. They also enhance oxidation of fatty acids in many tissues. Finally, plasma concentrations of cholesterol and triglycerides are inversely correlated with thyroid hormone levels - one diagnostic indiction of hypothyroidism is increased blood cholesterol concentration. Carbohydrate metabolism: Thyroid hormones stimulate almost all aspects of carbohydrate metabolism, including enhancement of insulin-dependent entry of glucose into cells and increased gluconeogenesis and glycogenolysis to generate free glucose.

Growth Growth hormones

CVS Increases heart rate, cardiac contractility and cardiac output. They also promote vasodilation, which leads to enhanced blood flow to many organs.

CNS Both decreased and increased concentrations of thyroid hormones lead to alterations in mental state. Too little thyroid hormone, and the individual tends to feel mentally sluggish, while too much induces anxiety and nervousness

Thyroid DrugsThyroid Drugs

• Synthetic replacement with Synthetic replacement with exogenous source of thyroid exogenous source of thyroid hormone.hormone.

Anti-thyroid DrugsAnti-thyroid Drugs

• Act by decreasing production or Act by decreasing production or release of thyroid hormones.release of thyroid hormones.

Nursing ProcessNursing Process• AssessmentAssessment

• WeightWeight• I/OI/O• Baseline v/sBaseline v/s• Head to toe assessmentHead to toe assessment• Blood levels of thyroid hormonesBlood levels of thyroid hormones• Sign and symptomsSign and symptoms• Adverse effects especially with Adverse effects especially with

glucocorticoidsglucocorticoids• ImplementationImplementation

• Administered IM, SC, IV, PO, topically, Administered IM, SC, IV, PO, topically, InhalantInhalant

Special Special ConsiderationsConsiderations

•DiabeticsDiabetics•May require frequent May require frequent adjustments of Insulinadjustments of Insulin

•More frequent monitoringMore frequent monitoring•May precipitate latent May precipitate latent diabetesdiabetes

•Adrenal insufficiencyAdrenal insufficiency•Use of glucocorticoids can cause Use of glucocorticoids can cause shutting off of the pituitary shutting off of the pituitary release of ACTHrelease of ACTH

•Situations producing stress may Situations producing stress may precipitate the need for an precipitate the need for an increase in dosage, until the increase in dosage, until the crisis is over.crisis is over.

•Risk of infectionRisk of infection•Report any signs of Report any signs of infection, sore throat, infection, sore throat, feverfever

•Protect pt against Protect pt against isolationisolation

•Risk for injuryRisk for injury•Signs of compression Signs of compression fractures, fractures, pathological fracturespathological fractures

•Skin injuriesSkin injuries

•Acute painAcute pain•Coffee grounds Coffee grounds emesis, tarry stools, emesis, tarry stools, epigastric painepigastric pain

•Excess fluid volumeExcess fluid volume•Check for edemaCheck for edema•I/OI/O•Daily weightDaily weight•Restrict sodium intakeRestrict sodium intake•Electrolyte ImbalanceElectrolyte Imbalance

EducationEducation• GI upset, take with foodGI upset, take with food• Do not stop abruptlyDo not stop abruptly• Follow taper instructionsFollow taper instructions• Weight weeklyWeight weekly• Excessive glucocorticoid levels resulting from Excessive glucocorticoid levels resulting from

administration as a drug or hyperadrenocorticism administration as a drug or hyperadrenocorticism have effects on many systems. Some examples have effects on many systems. Some examples include inhibition of bone formation, suppression include inhibition of bone formation, suppression of calcium absorption (both of which can lead to of calcium absorption (both of which can lead to osteoporosis), delayed wound healing, muscle osteoporosis), delayed wound healing, muscle weakness and increased risk of infection. weakness and increased risk of infection.

Medications That Affect The Endocrine System

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